Wanting a massage while pregnant? While you may desire to be on your tummy for a massage, here are a few reasons why this may not be the best position in terms of anatomy and comfort, even if the therapist has a "special" cut-out table or cushioning system for pregnant women. In the first three months, breasts may be very tender so lying on your stomach is not particularly comfortable. Especially when you consider the downward pressure the therapist will be using to address the upper back muscles, which will further compress the sensitive breasts. Pregnant women also tend to experience increased sinus issues, so being face down in a face cradle can create pressure in the sinus cavities. And most importantly, lying on your stomach, particularly once you are past 13 weeks, can increase the intrauterine pressure and it strains the ligaments that attach the uterus to the sacrum or tailbone. Being on our tummy can also re-create the sway back that is so common in pregnancy. This is the very position that is the cause of low back pain in the first place.
Our training, which includes over 45 years of collective experience, has convinced us that especially after 13 weeks, pregnant women should only be treated in a side-lying position. This position offers "maximum safety and comfort throughout all pregnancies" (Osborne 2012), even higher risk ones. The strain on uterine ligaments and muscles is minimized while on your side and it also helps to reduce pressure on the sinuses, breasts, and the uterus. Not only is this side-lying position very comfortable for the woman, it allows the therapist excellent access to the shoulder girdle, rib cage, low back, sacrum, and hips. Your therapist will be able to effectively address the nervous system, muscles, joints, and fascia to help reduce the physical load on the pregnant body. If you have had a treatment while lying on your side and found it to be uncomfortable, this is likely due to lack of skill and training on the therapist’s part. When positioned well on your side, the entire skeleton is held and supported by the body positioning cushions (with a few extra pillows to support the growing belly). It should feel like you are floating.
And in talking with my colleagues who are physiotherapists specializing in perinatal care (Optimum Perinatal Health Inc), here is what they say about being in a side-lying position for massages:
"Yes I would agree that side lying past 13 weeks pregnant is the best position for prenatal massage. We want to limit pressure on the uterus and the ligamentous structures supporting it. I believe it would be the safest position for mom and baby, especially when you factor in the pressure you would be using during a massage to release the posterior musculature." Gina-Marie Cerantola BSc, DPT, FCAMPT, CAFCI, CGIMS
"And another reason for avoiding a prone position is that the pressure on the linea alba is increased and women are then at increased risk of further abdominal separation. Although all women by 35 weeks gestation have SOME degree of abdominal separation (DRA) - (Mota et al. 2014) one does not want to make this worse!!" Corina Kerrison BSc PT, cMedical Acupuncture, BA Psych, cDoula